Access Keys Skip to Menu Skip to Content Skip to Footer

6.4 Sleep

Rooming-in in Hospital

Baby Friendly Step 7

Step 7 of the Ten Steps to Successful Breastfeeding states:
Practice rooming in - allow mothers and infants to remain together 24 hrs/day.

In their research to support the inclusion of this Step, UNICEF1 found that when mothers and infants were separated, infants breastfed less frequently, lactogenesis II was evident later and clinical jaundice was more common. Weight gain per day was also statistically less.

Babies cared for in nurseries had more crying episodes (and were therefore more stressed) and were responded to less frequently.

24-hr rooming in resulted in mothers experiencing the same number of hours total sleep as the separated dyads, infants spent 33% of the time in quiet sleep compared with only 25% in the nursery group and there was no difference in daytime alertness in the two groups.

This suggests that rooming-in does not greatly alter maternal sleep and it improves infants' sleep.

Workbook Activity 6.5

Complete Activity 6.5 in your workbook.

How long should my baby sleep?

Initially wakefulness and feeding are closely related. During the first 24 hours the newborn spends the first 2 hours awake and alert, and breastfeeding.

After the initial few days most babies will sleep about 16 hours a day, slowly decreasing to 14-15 hours by 3 months and 13-14 hours by 6 months of age.2

Interesting

By 3 weeks of age the average length of the longest sleep is about 3.5 hours. By 6 weeks of age some babies are having up to 6 hrs in one sleep.2

Neonates will often fall asleep directly in an 'active sleep' or REM (rapid eye movement) stage. It's during the active sleep stage that an infant is most easily roused. Neonates have a 50:50 relationship between active and quiet sleep, with sleep cycles lasting about 50 minutes.2

How can I use this knowledge to help parents?

Knowledge of what is normal behaviour is reassuring to parents. Discuss normal breastfeeding and sleep patterns with expectant or new parents. When putting a baby down to sleep suggest they stay with the baby until he moves from the rapid eye movement stage from which he is easily roused, into the deep sleep stage where he is more likely to stay asleep regardless of movement and noises around him.

The natural course of settling seems to proceed over the first 6 months, but even after that age increased waking occurs in up to 42% of children who have already shown the capacity to sleep through the night.2 Two thirds of babies breastfeed at night, and have their biggest feed at this time consuming 20% of their total daily intake.3 For these reasons implementing behavioral therapy for infant and toddler night-waking before 18 months of age is ill-advised.

Where should my baby sleep?

Definitions

Co-sleeping4 encompasses various sleeping situations with “having a responsive adult within proximity of the infant” (ie same room) being paramount.

Bedsharing is sleeping in the same bed.

Where the infant should sleep is a contentious issue. Prior to the 20th Century and the application of rules and regulations to childcare in the Western world, infants and mothers slept together, and still do in countries not influenced by Western customs. A recent UK study found that 72% of breastfeeding mothers consistently co-slept during the first 12 weeks of life.5 Bedsharing and breastfeeding are mutually reinforcing - breastfeeding couples are more likely to bedshare, and bedsharing babies are more likely to breastfeed successfully.4

Now that's significant!

Perhaps of even more significance to mothers is the finding of Quillin & Glenn (2004)6 that breastfeeding mothers who co-sleep get more total sleep than bottle feeding mothers or breastfeeding mothers who slept apart from their babies.

Research Findings

The results of fascinating research by McKenna & Mosko (1994)7 suggest that co-sleeping is associated with enhanced infant arousals and striking temporal overlap (synchronicity) in infant and maternal arousals, and that, possibly as a result, co-sleeping mothers and infants spend more time in the same sleep stage or awake condition. This synchronicity assists mothers to cope with broken sleep - the infant isn't rousing them at a time when they are in their quiet sleep phase.

Do you have a bed-sharing policy?

Click on the icon to be taken to a sample bedsharing policy produced by UK Baby Friendly. Print the article, read it and file it with your notes from this course.

Also read this Guideline for Co-sleeping and Breastfeeding from the Academy of Breastfeeding Medicine.

As it appears that breastfeeding mothers are likely to bedshare with their babies it is important to discuss how to do so safely.

Note this mother and her baby are on a firm mattress, she is turned toward her baby, her lower arm is not restricting infant movement. The bed linen is not covering the infant and he is sleeping safely on his back. This mother will respond immediately to her baby's cues to feed, and he can be easily rolled towards her to breastfeed.

Safe bedsharing with baby includes a firm mattress, supine sleep position and a breastfeeding mother.

Safe bedsharing with baby includes a firm mattress, supine sleep position and a breastfeeding mother.
Photograph © D.Fisher, IBCLC


Your Hospital Policy on Bedsharing

You have a legal responsibility to adhere to your hospital policy on bedsharing and ensure that the mother is aware of this for her hospital stay.

Now that you have read the research about safe bedsharing and co-sleeping, you may feel more confident about the many benefits and even infant safety advantages.
If your hospital does not allow bedsharing, you may like to form a group to gather research and present it to the hospital administrators.

What do you tell mothers about bedsharing?

You need to inform mothers about your hospital policy on bedsharing. However, it is also important for mothers to be given accurate information on safe bedsharing and co-sleeping at home with their baby.

Does your Unit have a leaflet you can discuss with mothers about safe bedsharing? If you don't have one, or it requires updating, form a small group to research the issue, share their findings with other staff, then create a leaflet for the purpose of educating mothers about this important aspect of parenting.

What should I remember?

  • The maternal and infant benefits of rooming-in.
  • The deleterious effects of keeping infants in newborn nurseries.
  • How normal sleep patterns progress from birth to older infant.
  • Safe bed-sharing techniques.

Self-test Quiz

Notes

  1. # Child and Adolescent Health and Development (CAH) (1998) Evidence for the ten steps to successful breastfeeding
  2. # de Weerd AW et al. (2003) The development of sleep during the first months of life
  3. # Kent JC et al. (2006) Volume and frequency of breastfeedings and fat content of breast milk throughout the day
  4. # McKenna JJ (2004, July) Examining Sudden Infant Death and Co-sleeping
  5. # Ball HL (2003) Breastfeeding, bed-sharing, and infant sleep
  6. # Quillin SI et al. (2004) Interaction between feeding method and co-sleeping on maternal-newborn sleep
  7. # McKenna JJ et al. (1994) Sleep and arousal, synchrony and independence, among mothers and infants sleeping apart and together (same bed): an experiment in evolutionary medicine